Menstrual Pain and How to Relieve It

A detailed look at the causes, varieties, and methods of relieving menstrual pain.

By Sandra Ritz

| November/December 1981

Menstrual pain is the leading cause of school and work absences among American women

ILLUSTRATION: FOTOLIA/CHUBPHONG

For this issue, Dr. Torn Ferguson's column was written
by the Women's Health Editor of Medical Self-Care.

Menstrual pain and discomfort—or
dysmenorrhea—is America's (and likely the
world's) number one gynecological problem. More
than half of all women who have periods also experience
monthly cramps. And, of those, approximately 10% suffer
pain severe enough to send them to bed for a day or more
each month. In fact, a 1978 study published in the
American Journal of Obstetrics and Gynecology
named dysmenorrhea as the greatest single cause of school
and work absences among American women (it accounts for the
loss of an estimated 140 million productive hours
annually).

The pain of menstrual cramps is all too real, but
traditionally physicians label the symptoms "psychogenic"
(originating in the mind) and prescribe either narcotics or
tranquilizers. And why do health care professionals tend to
take the condition lightly? Well, their seeming lack of
concern is likely due to the fact that dysmenorrhea hasn't
fit into the medical profession's accepted definition of
disease; that is, it couldn't (until recently) be
traced to an identifiable cause (such as a microorganism or
a toxin), and it doesn't result in any significant visible
injury (except the pain, which varies widely from woman to
woman). Now that attitude may be insensitive, but
it's not too surprising that women with a problem which
defies the very standards doctors are trained to view as
near sacred are often dismissed as "neurotic"!

The Culprit: Prostaglandins

However, there's no longer any reason to consider monthly
cramps as psychosomatic, because their cause has finally been identified. The
culprits, prostaglandins, are chemicals—produced by
tissues in the bodies of both males and females—which
stimulate the contractions in smooth muscles (one of which
is the uterus). The first link between prostaglandins and
dysmenorrhea was uncovered in 1957, when a British doctor
isolated some fat-like substances in menstrual blood that
appeared to stimulate uterine contractions. The
same chemicals were later identified as two types of
prostaglandins. Subsequent research showed that women who
suffer from severe dysmenorrhea have considerably higher
amounts of prostaglandins in their menstrual discharge than
do women who don't have painful cramps. It has also been
proved that birth control pills relieve cramps by
preventing ovulation and thus limiting the buildup of
prostaglandins that normally occurs during that part of the
menstrual cycle. Finally, it was found that chemical
prostaglandin inhibitors, such as aspirin, can help ease
the discomfort of dysmenorrhea. (In fact, Midol—a
popular over-the-counter cramp remedy—is mostly
aspirin.)

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In addition to prostaglandins, there are several other
factors that—it's speculated—contribute to
dysmenorrhea.

Family history. It hasn't yet been established
whether prostaglandin overproduction is hereditary, but
studies do show that daughters of women with severe
dysmenorrhea are likely to experience such cramps
themselves.

IUD's. Painful cramping is a common effect of IUD
usage ... and it now appears that intrauterine devices
actually stimulate prostaglandin production. Many
women have had them removed for that reason.

Other common troublemakers include bladder infections,
bowel problems, and yeast infections. It's also long been
noted that women who suffer acute dysmenorrhea often become
depressed and irritable as their periods approach (who
wouldn't, when anticipating several days of severe
pain?), and there was a time when doctors believed that
depression in women caused menstrual discomfort. I'd say it's more likely the other way around!

The Varieties of Dysmenorrhea

Whatever their origins, there are three separate kinds of
severe monthly cramping. Primary spasmodic
dysmenorrhea is characterized by sharp, wavelike
cramps—in the lower abdomen and inner
thighs—which last for a day or two after the onset of
menstruation. The condition usually subsides when a woman
reaches her late twenties. Primary congestive
dysmenorrhea, on the other hand, involves a dull, aching
pain and the uncomfortable, bloated feeling of edema. This
type of menstrual distress often persists until menopause,
getting worse with age.

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Secondary dysmenorrhea tends to occur suddenly,
often after years of less painful periods. It may
be associated with one of several health problems, some of
them as serious as pelvic inflammatory disease or
reproductive cancers. This ailment, therefore, should be
treated by a physician. The more common primary forms of
menstrual discomfort, though, can usually be alleviated—or
even eliminated—by following a carefully chosen
program of self-care.

Relief Is Up to You

The following list begins with "nonaggressive" approaches
menstrual pain relief, then moves on to more
drastic measures. You should feel free to use whatever
techniques suit your needs.

Exercise. Medical studies agree that as a woman's
physical condition improves, her cramps tend to lessen in
severity ... so going to bed when discomfort hits is actually
one of the worst things you can do! Any form of
mild exercise will help: Take a walk, ride your bike, or
try a few minutes of yoga. Certain postures—such as kneeling
on all fours with your head down and your hips
elevated—will sometimes help relieve cramping, too.

Diet. Individual women's reactions to foods vary
tremendously, but it's often said that dairy foods
aggravate menstrual-related bowel problems. Of course, if
you become constipated, you can alleviate the problem by
drinking more fluids (probably not milk) and increasing
your fiber intake. Word-of-mouth endorsement also speaks
well of dolomite (or any mixture of calcium and magnesium
in a 2:1 ratio). Begin taking the mineral supplements one
week before your period is due. (Eating more leafy
vegetables will also provide a calcium boost.)

Other women say that B vitamins—especially
B6—act as diuretics and help alleviate edema. And if
yeast infections are a problem, reduce your consumption of
sugar and take more buttermilk and yogurt for their
beneficial lactobacillus bacteria.

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Contraception. It's widely agreed that
dysmenorrhea is—to a certain extent—stress-related, and
the fear of an unwanted pregnancy can cause enormous
anxiety to accompany the onset of a woman's period (or the
lack of it). If you don't want to conceive, avoid
the worry by using contraception consistently.

Herb teas. Traditional remedies for cramps include
catnip, saffron, chamomile, mint, raspberry, and blackberry
leaf infusions. Dandelion and sassafras are mild diuretics,
so teas brewed from such herbs may help relieve a bloated
feeling.

Heat. Grandmother was right! Warm baths or a hot
water bottle held on the lower back or the abdomen will
work wonders.

Massage. Menstrual pain is often transferred to
the lower spinal area, so a soothing back massage with warm
coconut oil or another lubricant can really help. Some
women obtain relief from abdominal massage, as well.

Acupressure. This form of natural healing is
simply acupuncture without the needles: To use it, you
press a fingertip firmly on the appropriate points to
release blocked currents of energy. There are several
acupressure points that help relax the uterus. First,
stimulate the small hollow of bone that's one hand's width
above the ankle on the inside of the leg. Also try the
point two thumb widths up the inner arm, above the junction
of the wrist and arm and in line with the middle finger ... or the one between the nail and first joint of the middle
finger on the side toward the thumb.

Aspirin. This old standby is a mild prostaglandin
inhibitor, but it's only 1/30 as potent as the powerful
drugs listed below. Both plain and buffered
aspirin can cause stomach upset or gastrointestinal
bleeding, though, so be sure to take either of those
medications on a full stomach or with milk.

If the nonaggressive approaches listed above don't provide
enough relief, you probably ought to have a physical
(including a pelvic exam) to rule out any organic problems, particularly gonorrhea. At any rate, you will need to
see a doctor to obtain a prescription for any of the
following medications.

Prostaglandin inhibitors. These are the "latest
thing," which means they have both advantages and
disadvantages. They do work very well to reduce cramping,
but have also been known to cause such side effects as
rashes, headaches, gastrointestinal upset, and/or severe
bleeding. (Because the drugs are so new, other long-term
effects have not yet been determined.) If you're not using
any form of contraception in conjunction with the
prostaglandin inhibitors, don't take then until your
period actually starts. If you ingest the drug for a
few days before you expect your menstrual flow,
and it turns out that you've actually been pregnant for a
month, you'll have bathed the first-trimester fetus in a
possibly dangerous chemical.

Narcotics. Narcotics—especially
codeine—have long been administered to women
suffering severe cramps. Although they're
undoubtedly effective, the drugs can cause unpleasant side
effects (such as drowsiness, nausea, and constipation).
Personally, I'd suggest that you try to get by without
narcotics and instead use some form of stress reduction.
However, anyone with really debilitating pain
needs the strength of narcotics. For
such cases, I'm glad they're available. Addiction, by the
way, won't be a problem for anyone who takes narcotics for
only one or two days each month. It would require one or
two weeks of steady high doses to create a physical
dependence.

Birth control pills. As I mentioned earlier, the
Pill prevents ovulation, which is the signal for a buildup
of cramp-producing prostaglandin. Oral
contraceptives can be quite effective in relieving
menstrual pain. Each woman, I think, should weigh for
herself the costs and benefits of the Pill. There
are well-known health risks involved, but in
some cases the disadvantages may be preferable to severe
monthly pain.

EDITOR'S NOTE: Those of you who are interested in learning more
about acupressure will enjoy Michael Blate's text, The
Natural Healer's Acupressure Handbook: G-Jo Fingertip
Technique.

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